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This is VAERS ID 1051050

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1051050
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Cardiac failure acute, Cardiogenic shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': DEPFIZER INC2021173800

Write-up: Cardiogenic shock; Acute cardiac insufficiency; This is a spontaneous report from a non-contactable physician downloaded from the Agency Regulatory Authority-WEB (Regulatory Authority number DE-PEI-PEI2021002626). A 100 years old female received the first single dose of BNT162B2 (COMIRNATY) on 15Jan2021, for COVID-19 immunization. Medical history and concomitant medications were not reported. On 19Jan2021, four days after vaccination, the patient developed cardiogenic shock and acute cardiac insufficiency, lasting for 5 days. The patient died on an unspecified date in 2021. Cause of death was reported as acute cardiac insufficiency, however both cardiogenic shock and acute cardiac insufficiency were reported with a fatal outcome. Stop date of both events was reported as 23Jan2021 (death date was not clearly specified). It was unknown if an autopsy was done. Relatedness of drug to reaction(s)/event(s) assessed as D. Unclassifiable by Regulatory Authority. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Acute cardiac insufficiency; Cardiogenic shock

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